Key result
Preoperative continuation of ACEIs was associated with a significantly increased risk of vasoplegia after cardiac surgery (aOR 2.06) in observational studies.
Why the study?
Vasoplegia is a common complication of cardiac surgery, but whether preoperative renin-angiotensin system blockade causally contributes to it remains debated.
Does preoperative continuation of ACE inhibitors increase the risk of vasoplegia in patients undergoing cardiac surgery?
Meta-Analysis (n=15,672)
Does preoperative continuation of ACE inhibitors increase the risk of vasoplegia in patients undergoing cardiac surgery?
Answers are grounded in this paper and cite their sources.
Preoperative continuation of ACE inhibitors is associated with an increased risk of vasoplegia and need for postoperative inotropic support in observational studies, suggesting a potential benefit of holding these medications prior to cardiac surgery.
BACKGROUND: Vasoplegia is a common complication of cardiac surgery but its causal relationship with preoperative use of renin angiotensin system (RAS) blockers [angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB)] is still debated. AIM: To update and summarize data on the effect of preoperative use of RAS blockers on incident vasoplegia. METHODS: All published studies from MEDLINE, EMBASE, and Web of Science providing relevant data through January 13, 2021 were identified. A random-effects meta-analysis method was used to pool estimates, and post-cardiac surgery shock was differentiated from vasoplegia. RESULTS: 77%). Two randomized control trials (RCTs), not eligible for the meta-analysis, did not show an association between continuation of RAS blockers and vasoplegia. CONCLUSION: Preoperative continuation of ACEIs is associated with an increased need for inotropic support postoperatively and with an increased risk of vasoplegia in observational studies but not in RCTs. The absence of a consensus definition of vasoplegia should lead to the use of perioperative cardiovascular monitoring when designing RCTs to better understand this discrepancy.
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Noubiap et al. (2022) conducted a meta-analysis in Cardiac surgery (n=15,672). Preoperative continuation of ACEIs vs. Discontinuation or non-use of ACEIs was evaluated on Vasoplegia (aOR 2.06, 95% CI 1.45-2.93). Preoperative continuation of ACEIs was associated with a significantly increased risk of vasoplegia after cardiac surgery (aOR 2.06) in observational studies.
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